Ok, so I’d better make it clear. The “Radiology Department” in Wudinna consists of four radiographers. That’s a GP, GP registrar (me), the Director of Nursing and the CNC. The radiographs are taken in the A&E and then developed in an old broom cupboard with a fan. I thought that I would reflect back after taking my 20th x-ray tonight. It has been almost 3 months since completing the course that enabled us rural registrars to fire off energized photons into the atmosphere. My first x-ray (below) was of an old bloke who’d fallen onto his hand. I know now that I should have asked about any previous damage/operations to that wrist….”sorry, where exactly did your scaphoid bone go?!?”
This blog will document some of the good, bad and ugly radiographs that I have taken for educational purposes. It may also prove to be a repository of settings and views to call back on in the future.
So first up some tips I have learnt/gathered over this time (updated as required):
- Only a brave radiographer packs away the x-ray machine prior to developing the film.
- Take off all jewellery from the patient. Think also about watches, phones, metal zips and buckles, forgot for my first CXR (right)
- Always load fresh film into the cassette as soon as the exposed film is removed, nothing worse than taking an x-ray with a filmless cassette.
- With 15 room changes of air per minute, the developing room is the best place to fart.
- Don’t take the developing room/film cupboard key home with you.
- Label your film with patient name, DOB, body part and put L/R markers on.
- Check for pregnancy, always use gonad shielding for patient and lead apron/lead shield for yourself (don’t want children looking any more strange than they already will).
- Make sure the collecting hopper is clear of previous x-rays
- DON’T TAKE THE KEY HOME, GERRY!!
Today one of the films came out completely black. Stunned at the first x-ray that hadn’t worked out, I tried to remember the five reasons for such an occurrence (but had to look them up again):
- Film overexposed
- Processing times too long
- Ambient temperature too warm
- Film exposed to another light source
- Red safelight in developing room cracked
Checklist: the right settings were used, the machine was set up the same, the day wasn’t super hot and the film hadn’t been opened or exposed to white light. What had happened? So like any good doctor or engineer, or possibly any male, I took the x-ray again without changing anything! This time when putting the second film through the machine, I realised the first one had only just come out. The black film I’d pick up initially was a test film that had been run the day before by someone else and left in the hopper for an unsuspecting registrar. Another tip!
When it comes to evaluating a film there is a helpful acronym (PACEMAN) that radiographers often use for quality control. Note that this is not to do with interpreting an x-ray for diagnostic purposes, its more about working out how to improve the actual picture.
- P – Position
- A – Area covered
- C – Collimation
- E – Exposure
- M – Marker
- A – Aesthetics
- N – Name and DOB
So an evaluation of an x-ray make sound like “this is an AP view of a tib/fib. The ankle through to the knee is visible and collimated to the skin edges. The film is possibly a little over exposed, but good bony detail seen and the film is otherwise diagnostic. There is a left marker in place. The leg is lined up well on the film and the name/DOB have been removed for confidentiality.” It is important to think about the exposure especially as you may need to repeat the film and change the settings accordingly.
At the moment, Wudinna like many other towns around SA, use x-ray film and an automatic developing machine to produce images. Crystal Brook still has the old, old, old school method of manually dunking the film in each step of the process with a timer to help. Computed Radiology (CR) is a method of producing x-ray images straight to computer without film. This technology has been used at the major hospitals in the city for a few years now. Soon CR will be available at most small country hospitals in South Australia (already available at Jamestown, Ceduna and others?). This will certainly improve the quality of film, speed of referral and even the accuracy of reporting. Although there is a high initial cost for the system, running costs are vastly reduced as there is no need for ongoing purchase and disposal of hazardous chemicals or film. It will also mean that I can stop using the hospital camera or my iPhone for taking pictures for this blog and/or my friendly orthopaedic surgeon in Whyalla.
If you have any further pearls/gems/basic tenets of rural radiography…please comment!